Eissa MIA, Kaddoura R, Hassan D, Carr CS, Hanoura S, Shouman Y, Almulla A, Omar AS. Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure. World J Crit Care Med 2024; 13(3): 92658 [PMID: 39253311 DOI: 10.5492/wjccm.v13.i3.92658]
Corresponding Author of This Article
Amr Salah Omar, MD, PhD, Professor, Department of Cardiothoracic Surgery, Hamad Medical Cooperation, Alryan Road, Doha 3050, Qatar. a_s_omar@yahoo.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2024; 13(3): 92658 Published online Sep 9, 2024. doi: 10.5492/wjccm.v13.i3.92658
Table 1 Baseline characteristics among the studied population
Variable
All patients, n = 53
Narrow-spectrum antibiotics, n = 12
Broad-spectrum antibiotics, n = 41
P value
Demographics
Age in yr
59.0 ± 12.1
60.0 ± 13.4
58.7 ± 11.8
0.366
BMI in kg/m2
26.7 ± 4.9 (N = 52)
25.7 ± 3.7 (n = 12)
26.7 ± 5.2 (n = 40)
0.227
Sex
0.175
Male
45/53 (85.0)
12
33
Female
0
8
Ethnicity
0.011
African
3/53 (5.7)
3
0
Arab
24/53 (45.3)
4
11
Asian from Indian subcontinent
20/53 (37.7)
3
17
Asia
4/53 (7.5)
0
4
Western
2/53 (3.8)
1
1
Smoking status
0.402
Non-smoker
23/51 (45.1)
3
20
Smoker
7/51 (13.7)
1
6
Ex-smoker
21/51 (41.2)
6
15
Comorbidities
Hypertension
28/51 (54.9)
4
24
0.086
Diabetes
0.305
Type II
16/53 (30.2)
4
12
Type I
7/53 (13.2)
0
7
COPD
2/52 (3.8)
0
2
1.00
CKD
8/53 (15.1)
1
7
0.665
On dialysis
2/53 (3.8)
0
2
1.00
PVD
2/53 (3.8)
0
2
1.00
Statin use
24/52 (46.2)
5
19
0.722
ECHO
LVEF as %
43.4 ± 16.9
45.8 ± 12.9
42.7 ± 18.0
0.578
LVEF groups
0.309
Good, > 50%
23/53 (43.4)
4
19
Moderate, 31%-50%
16/53 (30.2)
6
10
Poor, 21%-30%
10/53 (18.9)
2
8
Very poor, ≤ 20%
4/53 (7.5)
0
4
Table 2 Laboratory test measurements among the studied population
Variable
All patients, n = 53
Narrow-spectrum antibiotics, n = 12
Broad-spectrum antibiotics, n = 41
P value
Creatinine in micromole/L
95.0 (72.0-110) (N = 51)
79.0 (ΔIQR 24.0) (n = 11)
95.0 (ΔIQR 46.0) (n = 40)
0.688
Highest creatinine in micromole/L
110 (85.0-175) (N = 51)
95.0 (ΔIQR 29.0) (n = 11)
107.5 (ΔIQR 106) (n = 40)
0.457
Bilirubin in micromole/L
9.0 (6.9-17.1) (N = 47)
8.6 (ΔIQR 26.5) (n = 10)
9.5 (ΔIQR 6.7) (n = 37)
0.755
SGPT in U/L
26.0 (18.0-40.0) (N = 47)
18.0 (ΔIQR 13.5) (n = 9)
25.5 (ΔIQR 22.3) (n = 38)
0.185
HbA1c as %
6.3 ± 1.6
5.9 ± 1.7
6.3 ± 1.5
0.243
Hb in mg/dL
12.9 ± 2.0 (N = 52)
13.2 ± 1.9 (n = 12)
12.7 ± 2.0 (n = 40)
0.239
WBC as 103/U
10.8 ± 5.2 (N = 49)
6.8 (ΔIQR 4.0) (n = 10)
8.8 (ΔIQR 3.0) (n = 39)
0.076
Table 3 Peri-procedural findings
Variable
All patients
Narrow-spectrum antibiotics, n = 12
Broad-spectrum antibiotics, n = 41
P value
Procedure data
0.398
CABG
31/53 (58.5)
7
24
Valve replacement
11/53 (20.8)
4
7
Combined CABG/valve surgery
6/53 (11.3)
0
6
Aortic dissection
5/53 (9.4)
1
4
Epicardial wires
16/52 (30.8)
4
12
1.00
CPB in min
165 ± 75.3 (N = 50)
127.3 ± 67.9 (n = 10)
174.4 ± 74.9 (n = 40)
0.037
ACC in min
85.0 ± 45.7 (N = 41)
83.2 ± 50.5 (n = 9)
85.4 ± 45.1 (n = 32)
0.451
Open chest duration in d
3.0 (2.0-5.0)
2.0 (ΔIQR 2.0)
3.0 (ΔIQR 2.0)
0.146
Intraoperative transfusion
41/52 (78.8)
10
31
1.00
Postoperative transfusion
49/51 (96.1)
12
37
1.00
Blood loss in mL
At 6 h
700 (375-1350) (N = 45)
900 (ΔIQR 1050) (n = 11)
1050 (ΔIQR 1250) (n = 34)
0.864
At 12 h
1225 (500-2050) (N = 44)
1750 (ΔIQR 1000) (n = 11)
1575 (ΔIQR 2088) (n = 33)
0.881
At 24 h
1700 (775-2800) (N = 45)
1900 (ΔIQR 2500) (n = 11)
2175 (ΔIQR 3213) (n = 34)
0.8443
Total loss
2400 (1362-4700) (N = 44)
2050 (ΔIQR 4375) (n = 11)
3325 (ΔIQR 4300) (n = 33)
0.492
Support
Inotropes/vasopressors use
Agent(s) use
46/47 (97.9)
11
35
1.00
Number of agent(s) used
0.385
0
2/49 (4.1)
0
2
1
3/49 (6.1)
2
1
2
16/49 (32.7)
4
12
3
20/49 (40.8)
5
15
4
8/49 (16.3)
1
7
Number of agents used
2.6 ± 0.9 (N = 49)
2.4 ± 0.9 (n = 12)
2.6 ± 1.0 (n = 37)
0.24
IABP use
27/53 (50.9)
6
21
0.941
Defibrillation
13/53 (24.5)
3
10
1.00
Table 4 Clinical outcomes
Variable
All patients
Narrow-spectrum antibiotics, n = 12
Broad-spectrum antibiotics, n = 41
P value
New nosocomial infection
20/50 (40.0)
5
15
0.736
Time to sepsis/septic shock postoperatively in d
4.8 ± 2.6 (N = 50)
3.0 (ΔIQR 4.0) (n = 11)
3.5 (ΔIQR 2.0) (n = 39)
0.586
POAF
24/52 (46.2)
5
19
0.722
New ECG changes
39/51 (76.5)
9
30
1.00
Heart block
7/52 (13.5)
2
5
0.656
LV dysfunction
7/52 (13.5)
0
7
0.181
Postoperative MI
2/52 (3.8)
0
2
1.00
New postoperative stroke
0.576
Transient
3/50 (6.0)
0
3
Permanent
5/50 (10.0)
1
4
Duration of ventilation in h
70.0 (39.0-190)
50.0 (ΔIQR 113)
60.0 (ΔIQR 170)
0.047
LOS-ICU in d
8.0 (3.25-15.5) (N = 52)
5.0 (ΔIQR 5.0) (n = 12)
7.5 (ΔIQR 10.0) (n = 40)
0.008
LOS-hospital in d
27.0 (10.5-47.0) (N = 44)
19.0 (ΔIQR 21.0) (n = 11)
27.0 (ΔIQR 30.0) (n = 33)
0.031
Mortality
18/52 (34.6)
4
14
1.00
Readmission to ICU
5/51 (9.8)
1
4
1.00
Citation: Eissa MIA, Kaddoura R, Hassan D, Carr CS, Hanoura S, Shouman Y, Almulla A, Omar AS. Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure. World J Crit Care Med 2024; 13(3): 92658